Tongdu Zhiyu Acupuncture Improves Post-Stroke Depression by Upregulating miR-223-3p and Inhibiting NLRP3 Inflammasome: a Clinical Study

OBJECTIVE: To investigate the mechanism of Tongdu Zhiyu acupuncture in the treatment of post‐stroke depression (PSD). METHODS: A randomized controlled trial was conducted. Sixty‐two PSD patients from the Department of Brain Disease, the Second Affiliated Hospital of Anhui University of Traditional Chinese Medicine were enrolled and randomly assigned in a 1∶1 ratio to a control group (n = 31) or an experimental group (n = 31). All patients received basic treatment. The control group received ordinary acupuncture, while the experimental group received ordinary acupuncture combined with Tongdu Zhiyu acupuncture. The treatment period was 8 weeks. The primary outcome was the total score on the 24‐item Hamilton Depression Scale (HAMD‐24). Secondary outcomes included the National Institutes of Health Stroke Scale (NIHSS) score, Barthel index, peripheral blood mononuclear cell miR‐223‐3p expression, and serum levels of NLRP3, IL‐1β, and IL‐18. RESULTS: After treatment, all indicators in the experimental group improved significantly compared with baseline (all P < 0.05), and the improvements were significantly greater than those in the control group (all P < 0.05). The HAMD‐24 score decreased from 17.87 ± 3.90 to 13.04 ± 3.55; the NIHSS score decreased from 23.29 ± 6.74 to 9.97 ± 5.81; the Barthel index increased from 32.29 ± 5.37 to 87.13 ± 6.82; miR‐223‐3p expression increased from 0.29 ± 0.07 to 0.98 ± 0.21; serum NLRP3 decreased from (65.84 ± 7.16) ng/L to (49.56 ± 4.89) ng/L; IL‐1β decreased from (43.92 ± 7.25) pg/mL to (22.24 ± 4.76) pg/mL; and IL‐18 decreased from (30.70 ± 4.13) pg/mL to (15.40 ± 3.09) pg/mL. CONCLUSION: Tongdu Zhiyu acupuncture can improve neurological function in PSD patients. Its mechanism may involve upregulating miR‐223‐3p expression, inhibiting NLRP3 inflammasome activation, and reducing the release of pro‐inflammatory cytokines such as IL‐1β and IL‐18, thereby alleviating depressive symptoms.